ArticlePDF Available

Abstract and Figures

Background BDSM is an abbreviation used to reference the concepts of bondage and discipline, dominance and submission, sadism and masochism, enacted by power exchanges between consensual partners. Although pain is an evolutionary protection mechanism to prevent individuals from further exposing themselves to damage, afflicting or receiving pain is a core element of BDSM play. Aim To shed light upon the rewarding biological mechanisms associated with BDSM interactions. Methods Dominant and submissive counterparts of 35 BDSM couples were recruited through Fetlife, a BDSM-themed internet forum, and by word-of-mouth within the Belgian BDSM community. In order to control for social evening interaction effects, non-BDSM interested controls (n=27) were recruited at the bar of a local sports club and by word-of-mouth. Main outcome measures We compared the evolution of the stress and reward hormone levels of cortisol, beta-endorphins and endocannabinoids (2AG and AEA) in a group of BDSM practitioners before and after an active BDSM interaction with the levels in control individuals. Results We showed that submissives showed increases in cortisol levels due to BDSM interactions. Endocannabinoid levels in submissives increased during the play compared to the control group, but no such increase was observed in dominants. However, when taking play type into account, dominants showed a significant increase in endocannabinoids associated with power play but not with pain play. Conclusion Even though this is one of the first studies of its kind, we can conclude that there is a clear indication for increased pleasure in submissives when looking at biological effects of a BDSM interaction, which was related to the increases in experienced stress.
Content may be subject to copyright.
Between pleasure and pain: a pilot study on the biological mechanisms
associated with BDSM interactions in dominants and submissives
Authors:
Dr. E Wuyts 1 ; Dr. N De Neef 2 ; V Coppens 1,3 ; E Fransen 4 ; E Schellens 1,3 ; M
Van Der Pol 5 ; Prof. M Morrens 1,3
Affiliations:
1 Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine
and Health Sciences, Campus Drie Eiken, University of Antwerp, Antwerp, Belgium,
manuel.morrens@uantwerpen.be.
2 Europe Hospitals, Campus St Michel, Brussels, Belgium.
3 University Department of Psychiatry, Campus Duffel, Duffel, Belgium,
manuel.morrens@uantwerpen.be.
4 StatUA, University of Antwerp, Antwerp, Belgium, erik.fransen@uantwerpen.be
5 VZW 78/Fetish Club 78, Ham, Belgium
!
!
!
!
!
Abstract:!
Background+
!"#$% &'% ()% (**+,-&(.&/)% 0',1% ./% +,2,+,)3,% .4,% 3/)3,5.'% /2% */)1(6,% ()1%
1&'3&57&),8%1/9&)()3,%()1%'0*9&''&/)8%'(1&'9%()1%9('/34&'98%,)(3.,1%*:%5/;,+%
,<34()6,'% *,.;,,)% 3/)',)'0(7% 5(+.),+'=% >7.4/064% 5(&)% &'% ()% ,-/70.&/)(+:%
5+/.,3.&/)%9,34()&'9%./%5+,-,).%&)1&-&10(7'%2+/9%20+.4,+%,<5/'&)6%.4,9',7-,'%
./%1(9(6,8%(227&3.&)6%/+%+,3,&-&)6%5(&)%&'%(%3/+,%,7,9,).%/2%!"#$%57(:=%%
Aim+
?/%'4,1%7&64.%05/)%.4,%+,;(+1&)6%*&/7/6&3(7%9,34()&'9'%(''/3&(.,1%;&.4%%!"#$%
&).,+(3.&/)'=%%
Methods+
"/9&)().% ()1% '0*9&''&-,% 3/0).,+5(+.'% /2% @A% !"#$% 3/057,'% ;,+,% +,3+0&.,1%
.4+/064% B,.7&2,8% (% !"#$C.4,9,1% &).,+),.% 2/+098% ()1% *:% ;/+1C/2C9/0.4% ;&.4&)%
.4,%!,76&()%!"#$%3/990)&.:=%D)%/+1,+%./%3/).+/7%2/+% '/3&(7% ,-,)&)6% &).,+(3.&/)%
,22,3.'8%)/)C!"#$%&).,+,'.,1%3/).+/7'%E)FGHI%;,+,%+,3+0&.,1%(.%.4,%*(+%/2%(%7/3(7%
'5/+.'%370*%()1%*:%;/+1C/2C9/0.4=%%
Main+outcome+measures++
J,%3/95(+,1%.4,%,-/70.&/)%/2%.4,%'.+,''%()1%+,;(+1%4/+9/),%7,-,7'%/2%3/+.&'/78%
*,.(C,)1/+54&)'% ()1% ,)1/3())(*&)/&1'% EG>K% ()1% >L>I% &)% (% 6+/05% /2% !"#$%
5+(3.&.&/),+'% *,2/+,% ()1% (2.,+% ()% (3.&-,% !"#$% &).,+(3.&/)% ;&.4% .4,% 7,-,7'% &)%
3/).+/7%&)1&-&10(7'=%%
Results+
J,% '4/;,1%.4(.% '0*9&''&-,'% '4/;,1% &)3+,(','% &)% 3/+.&'/7% 7,-,7'% 10,% ./% !"#$%
&).,+(3.&/)'=% L)1/3())(*&)/&1% 7,-,7'% &)% '0*9&''&-,'% &)3+,(',1% 10+&)6% .4,% 57(:%
3/95(+,1%./%.4,%3/).+/7%6+/058%*0.%)/%'034%&)3+,(',%;('%/*',+-,1%&)%1/9&)().'=%
M/;,-,+8%;4,)% .(N&)6% 57(:% .:5,% &)./% (33/0).8% 1/9&)().'% '4/;,1% (% '&6)&2&3().%
&)3+,(',%&)%,)1/3())(*&)/&1'%(''/3&(.,1%;&.4%5/;,+%57(:%*0.%)/.%;&.4%5(&)%57(:=%%
Conclusion+
L-,)%.4/064%.4&'%&'%/),%/2%.4,%2&+'.%'.01&,'%/2%&.'%N&)18%;,%3()%3/)3701,%.4(.%.4,+,%
&'% (% 37,(+% &)1&3(.&/)%2/+% &)3+,(',1% 57,('0+,% &)% '0*9&''&-,'% ;4,)% 7//N&)6% (.%
*&/7/6&3(7% ,22,3.'% /2% (% !"#$% &).,+(3.&/)8% ;4&34% ;('% +,7(.,1% ./% .4,% &)3+,(','% &)%
,<5,+&,)3,1%'.+,''=%%
!
! !
Introduction:!
!"#$% &'% ()% (**+,-&(.&/)%0',1%./% +,2,+,)3,% .4,% 3/)3,5.'% /2% */)1(6,% ()1%
1&'3&57&),8%1/9&)()3,%()1%'0*9&''&/)8%'(1&'9%()1%9('/34&'98%;4&34%,)3/95(''%
5':34/7/6&3(7% ()1% 54:'&3(7% +/7,C57(:% &)-/7-&)6% 5/;,+% ,<34()6,'% *,.;,,)%
3/)',)'0(7%5(+.),+'=%?4,',%&).,+(3.&/)'%/2.,)% +,-/7-,% (+/0)1% 5/;,+% &9*(7()3,%
()1%,7,9,).'%/2%5(&)%EOI=%!"#$%&'%2+,P0,).7:%',<0(7&Q,18%.4/064%',<0(7%3/).(3.%/+%
6+(.&2&3(.&/)%(+,%/2.,)%)/.%(%5+,+,P0&'&.,%2/+%,)6(6,9,).%EGI=%%%
R&2,.&9,%5+,-(7,)3,%)09*,+'%&)%.4,%6,),+(7%5/507(.&/)% +()6,% 2+/9% @O% ./% STU% 8%
,'5,3&(77:% ;4,)% (7'/% 3/)'&1,+&)6% '/2.,+%!"#$C+,7(.,1% (3.&-&.&,'%E,=6=%
*7&)12/71&)6I% EGCVI=% #5,3&2&3(77:8% (%7(+6,C'3(7,% +,3,).% '.01:% *:% M/7-/,.% ,.% (7%
'066,'.'% .4(.% VS=WU% /2% .4,% 6,),+(7% 5/507(.&/)% 4('%,)6(6,1% &)% !"#$C+,7(.,1%
(3.&-&.&,'%(.%7,('.%/)3,%EVI=%
%
?4/064% !"#$% 5+(3.&3,% &'% 9034% 9/+,% 3/99/)% .4()% 5+,-&/0'7:% .4/064.8% .4,%
5':34/7/6&3(7% ()1% *&/7/6&3(7% 2(3./+'% 1+&-&)6%.4,',% &).,+,'.'% ()1% 5+(3.&3,'%(+,%
'3(+3,7:% &)-,'.&6(.,1=% X+(3.&.&/),+'% /2.,)% +,2,+% ./%Y'0*C'5(3,Z% ()1% Y1/9C'5(3,Z%
('%.4,% ,054/+&3% '.(.,% (% !"#$% &).,+(3.&/)% 3()% &)103,% EAI=% ?4,',% '0*[,3.&-,%
&).,+5+,.(.&/)'%5/&).% ./;(+1'%()% &).+&3(.,% &).,+(3.&/)% *,.;,,)%',)'(.&/)'% /2%
57,('0+,%()1%.4,%(3.%/2% (227&3.&)6% /+% +,3,&-&)6% 5(&)8% ;4&34%3/071%*,%3/95(+,1%./%
.4,%'/C3(77,1% \+0)),+]'%4&64]%('%(%+,'07.%/2%7/)6C1&'.()3,%+0))&)6%ESI=%?4,%10(7&.:%
/2%57,('0+,%()1%5(&)%4('%*,,)%(3N)/;7,16,1%907.&57,%.&9,'%/-,+%.4,%:,(+'8%;&.4%
J,&)*,+6% ()1% 3/77,(60,'% .4,/+&Q&)6% .4(.% 5(&)% 3()% (3.% ('% (% ',<0(7% '.&9070'% EHI=%
#&9&7(+7:8% ^&)',:% 5/&).,1% /0.% %.4(.% .4,% 54:'&/7/6&3(7% +,'5/)',% ./% 5(&)% &'% -,+:%
'&9&7(+%./%.4(.%/2%()%/+6('9%EWI=%%
_)2/+.0)(.,7:8% ('% /2% ./1(:8% 7&9&.,1% (..,).&/)% 4('% *,,)% 5(&1% ./% .4,% &).,+57(:%
*,.;,,)%5(&)% ()1%5/;,+%57(:%/)%/),%4()1%()1% ,<5,+&,)3,1%57,('0+,%/+%+,;(+1%
/)% .4,% /.4,+8% ,&.4,+% /)% (% 54,)/9,)/7/6&3(7% E`I8% (% 5':34/7/6&3(7% EOTI% /+% (%
*&/7/6&3(7%7,-,7%EOOI=%
B/+% .4,% +,9(&)1,+% /2% .4&'% '.01:8% .4,% 2/77/;&)6% 1,2&)&.&/)'% '4(77% *,% 0',1=% X/;,+%
57(:% 3()% *,% 1,2&),1% ('% .4,% &)370'&/)% /2% 5/;,+% &9*(7()3,'% ;&.4&)% .4,% !"#$%
&).,+(3.&/)=% X(&)% 57(:% 3()% *,% 1,2&),1% ('% .4,% &)370'&/)% /2% 5(&)207% '.&907(.&/)%
;&.4&)%.4,%!"#$%&).,+(3.&/)=%
%
#,-,+(7% 4/+9/),'% 4(-,% *,,)% 50.% 2/+;(+1% ('% *&/9(+N,+'% &)% .4,% ('',''9,).% /2%
57,('0+,%/+%+,;(+1=%L)1/+54&)'%(+,%5,+4(5'%.4,%9/'.%'.01&,1%()1%4(-,%,(+),1%
.4,%)(9,% \57,('0+,% 4/+9/),]%('% (% +,'07.%EOGI=% %M/;,-,+8% .4,',% 7(+6,% 9/7,307,'%
;&77% )/.% 1&+,3.7:% 5(''%.4,% *7//1C*+(&)% *(++&,+% E!!!I8% ;4&34% 3/957&3(.,'% /0+%
0)1,+'.()1&)6%/2%.4,&+%+/7,% &)%.4,%*+(&)=%a,3,).7:8%(..,).&/)%4('% '4&2.,1% ./;(+1'%
.4,% 7&5&1C*(',1% ,)1/3())(*&)/&1'% GC(+(34&1/)/:767:3,+/7% EGC>KI% ()1%
()()1(9&1,% E>L>I8% ;4&34% 3()% 5(''% .4,% !!!% EO@I=% a,',(+34% 2/30'&)6% /)%.4,%
9,34()&'9'%*,4&)1%.4,%\+0)),+]'%4&64]%+,-,(7,1%.4,',%,)1/3())(*&)/&1'%./%57(:%
(% 3+03&(7% +/7,% &)%'5,3&2&3(77:% (30.,% ()<&/7:'&'% ()1% ()(76,'&(% (2.,+% +0))&)6% EOVI=%
>7'/% &)% ',<0(7% 3/).,<.'8% .4,',% ,)1/3())(*&)/&1'% 4(-,% *,,)% (''/3&(.,1% ;&.4%
,<5,+&,)3&)6%',<0(7% 57,('0+,% EOAI% ()1% ',<0(7% 9/.&-(.&/)% EOSI=% B/+% ,<(957,8%
',<0(7% ',72C'.&907(.&/)% +,'07.'% &)%&)3+,(',1% 57('9(% 7,-,7'% /2% GC>K% &)% 9(7,% ()1%
2,9(7,%-/70).,,+'% EOHI=% %>'% '0348% &)-,'.&6(.&)6% .4,% +/7,% /2% ,)1/3())(*&)/&1'%('%
+,;(+1C+,7(.,1% *&/9(+N,+'% 5+/-&1,'% (% 5+/9&'&)6% (-,)0,% &)% 0)+(-,77&)6% .4,%
*&/7/6&3(7%9,34()&'9'%/2%,<5,+&,)3&)6%+,;(+1%',)'(.&/)'%&)%!"#$=%
>'%'.+,''/+'%7&N,%5/;,+%57(:%()1%5(&)%(+,%3/+,%2,(.0+,'%/2%!"#$8%/.4,+%+,',(+34%
4('% '4/;)% .4(.% .4,% '.+,''% ':'.,9% 57(:'% ()% ,P0(77:%3+03&(7% +/7,% &)% .4,% !"#$%
,<5,+&,)3,=%>'%'0348%EOOI%1,9/)'.+(.,1%7,-,7'%/2%.4,%'.+,''%4/+9/),%3/+.&'/7%./%
&)3+,(',% 10+&)6% !"#$% 57(:% &)% (% '9(77% '(957,% /2% '0*9&''&-,'=% D)% .4&'% 7&),8%
&)3+,(',1% '.+,''% ()1% ()<&/0'),''% 4('% (7'/% *,,)% +,7(.,1% ./% /.4,+% (3.&-&.&,'%
1,,9,1%57,('0+(*7,8%'034%('%;(.34&)6%4/++/+%/+%-&/7,).%9/-&,'%EOWI=%
%
b/9*&),18%.4,%(*/-,%2&)1&)6'%30907(.,%&)%.4,%4:5/.4,'&'%.4(.%!#"$%&).,+(3.&/)'%
(+,%*&/7/6&3(77:%9&++/+,1%*:%()%&)3+,(',%&)%'.+,''%()1%+,;(+1%4/+9/),'=%
?4,% 30++,).% 5&7/.% '.01:%.4,+,2/+,%5&/),,+'% &)%&)-,'.&6(.&)6%.4,% ,22,3.'%/2% !"#$%
57(:% /)% *,.(C,)1/+54&)'8% GC>K8% >L>% ()1% 3/+.&'/7% &)% 1/9&)().% ()1% '0*9&''&-,%
5(+.&3&5().'%'/% ('%./% ,<57/+,% ./% ;4(.% ,<.,).% *&/7/6&3(7% ':'.,9'% /2% '.+,''% ()1%
+,;(+1%(+,%&)-/7-,1%&)%!"#$=%
!
! !
Materials!and!methods:!
Participants+
"/9&)().% ()1% '0*9&''&-,% 3/0).,+5(+.'% /2% @A% !"#$% 3/057,'% ;,+,% +,3+0&.,1%
.4+/064% B,.7&2,8% (% !"#$C.4,9,1% &).,+),.% 2/+098% ()1% *:% ;/+1C/2C9/0.4% ;&.4&)%
.4,%!,76&()%!"#$%3/990)&.:=%
X(+.&3&5().'% ;&.4% 5(&)% 9,1&3(.&/)8% ),0+/7/6&3(7% 3/)1&.&/)'% (22,3.&)6% 5(&)%
5,+3,5.&/)% /+% (3.&-,% 1,5+,''&-,% ':95./9(./7/6:% E('% 1,2&),1% *:% (% !,3N%
",5+,''&/)%#3/+,%E!"DI%'3/+,%/2%%OV%/+%4&64,+I%;,+,%,<3701,1%2+/9%.4,%'.01:8%('%
1,5+,''&-,% ':95./9(./7/6:% &'% (''/3&(.,1% ./% .4,% (*&7&.:% ./% ,<5,+&,)3,% 57,('0+,=%
#;&.34,'8% &=,=% 5,/57,% ;4/% (7.,+)(.,% *,.;,,)% (% '0*9&''&-,% ()1% (% 1/9&)().% +/7,8%
;,+,%(77/;,1%./%5(+.&3&5(.,8%*0.%4(1%./%9(&).(&)%/),%+/7,%.4+/064/0.%.4,%'.01:%
&).,+-,).&/)%5,+&/1=%%
D)% /+1,+% ./% 3/).+/7% 2/+% '/3&(7% ,-,)&)6% &).,+(3.&/)% ,22,3.'8% )/)C!"#$% &).,+,'.,1%
3/).+/7'%E)FGHI%;,+,%+,3+0&.,1%(.%.4,%*(+%/2%(%7/3(7%'5/+.'%370*%()1%*:% ;/+1C/2C
9/0.4=%%
!"#$%5+(3.&.&/),+'%;4/%5(+.&3&5(.,1%&)%.4,%'.01:%;,+,%6+().,1%2+,,%,).+()3,%./%
.4,% !"#$% 370*% ;4,+,% .4,% &)370'&/)'% ;,+,% 1/),8% ;4&34% (9/0).,1% ./% cGA% 5,+%
5,+'/)=%?4,%3/).+/7%6+/05% +,3,&-,1% .4,% '(9,%(9/0).%('%3/95,)'(.&/)%2/+%.4,&+%
5(+.&3&5(.&/)=%
X(+.&3&5().'%&)%*/.4%6+/05'%;,+,%('N,1%./%7&9&.%.4,&+%(73/4/7%3/)'099(.&/)%./%(%
9(<&909% /2% G% 0)&.'% ;4&7,% .(N&)6% 5(+.%&)% .4,% '.01:8% &)% ;4&34% O% (73/4/7% 0)&.% &'%
1,2&),1%('%OT97%/2%(73/4/7%()1%3()%*,%&).,+5+,.,1%('%O%67(''%/2%*,,+%/+%O%67(''%/2%
;&),=%
X(+.&3&5().'% ;,+,% +,3+0&.,1% *,.;,,)% B,*+0(+:% GTOW%()1% d/-,9*,+% GTOW=% ?4,%
'.01:% ;('% (55+/-,1% *:% .4,% b/99&..,,% 2/+% $,1&3(7% L.4&3'% /2% .4,% _)&-,+'&.:%
M/'5&.(7% >).;,+5% ()1% .4,% >).;,+5% _)&-,+'&.:=% >77% 5(+.&3&5().'% (6+,,1% ./%
5(+.&3&5(.,%&)%.4,% '.01:% ()1% '&6),1% &)2/+9,1% 3/)',).=%?4,%'.01:%3/957&,1% ;&.4%
.4,%",37(+(.&/)%/2%M,7'&)N&=%
%
Study+design+
>77%!"#$%3/057,'%;,+,%.,'.,1%/)%'&.,%&)%efJ%HWgB,.&'4%b70*%HW8%(%!,76&09C*(',1%
!"#$% 370*8% 10+&)6% ,-,)&)6% 57(:% ,-,).'=% % X(+.&3&5().'% ;,+,% &)2/+9,1% (*/0.% .4,%
'.01:% 5+/./3/78% '&6),1% &)2/+9,1% 3/)',).% ()1% '0*',P0,).7:% 3/957,.,1% (%
P0,'.&/))(&+,% 6(06&)6% 1,9/6+(54&3% -(+&(*7,'% ()1%!"#$% &).,+,'.'% ()1% 2&77,1% &)%
.4,%!"D=%D2%2/0)1%,7&6&*7,8%(%5+,C57(:%*7//1%'(957,%EOT%97I%;('%3/77,3.,1%()1%-&.(7%
5(+(9,.,+'% &)3701&)6% *7//1% 5+,''0+,8% 4,(+.% +(.,% ()1% !$D% ;,+,% ('','',1=% ?4,%
3/057,'%;,+,%&)'.+03.,1%./%57(:%2/+%(%.&9,%5,+&/1%/2%9&)&909%@T%()1%9(<&909%
`T%9&)0.,'=%J4,)%.4,%3/057,'%'.(+.,1%.4,&+%!"#$%57(:8%()%/*',+-,+%+(.,1%.4,',%
&).,+(3.&/)'%/)% (%5+,C2&<,1%',.% /2%5(+(9,.,+'%3/)3,+)&)6%7,)6.4%()1%.:5,%/2%57(:%
E5(&)% 57(:8% 5/;,+% 57(:8% /*',+-,1%',<0(7% &).,+(3.&/)'8====I=% ?4,',% 5(+(9,.,+'%
:&,71,1% (% *&)(+:% '3/+,8% ;4&34% &957&,'% &)1&3(.&)6% ;4,.4,+% .4,% /*',+-,+% 1,,9,1%
.4,',%3(.,6/+&,'%/2%57(:%./%*,%5+,',).%/+%)/.%E,=6=%5(&)%57(:%5+,',).h%:,'g)/I=%?4&'%
9,()'%.4(.%5(&)%57(:8%5/;,+%57(:8%()1%',<0(7%&).,+(3.&/)'%3/071%(77%*,%5+,',).%&)%
.4,% '(9,% /*',+-(.&/)=%%a(.&)6% 9,.4/1% ;('% 1&'30'',1%*,2/+,% ()1% (2.,+%,(34%
&).,+(3.&/)=%#/9,%&).,+(3.&/)'%;,+,% /*',+-,1% *:% .;/%/*',+-,+'%'&907.(),/0'7:8%
;4&34%4,75,1%9&)&9&',%&).,++(.,+%-(+&(*&7&.:=%%
B/77/;C05% *7//1% ('',''9,).% E?GI% ;('% 3/957,.,1% 1&+,3.7:% (2.,+% .4,% ,)1% /2% .4,%
57(:8% (2.,+% ;4&34% 5(+.&3&5().'% .:5&3(77:% E*0.% )/.% ),3,''(+&7:I% ,).,+% (% 54(',% /2%
(2.,+3(+,8%&=,=%(% 5,+&/1%/2%+,27,3.&/)%()1%&).&9(.,% 3/).(3.%'034%('%'&..&)6%./6,.4,+%
/+% 30117&)6=% ?/% (33/0).% 2/+% .4&'% 54(',8% (% .4&+1% *7//1% ('',''9,).% E?@I% ;('%
3/957,.,1% OACGT% 9&)0.,'% (2.,+% ?G% E.:5&3(77:% (2.,+% .4,% (2.,+3(+,% 5,+&/1% 4(1%
3/)3701,1I=%
>2.,+;(+1'8% 1/9&)().'% ()1% '0*9&''&-,'% +,3,&-,1% (% '4/+.% 1,*+&,2&)6%
P0,'.&/))(&+,% &)% ;4&34% .4,:% 3/071% +(.,% .4,% &).,+(3.&/)% E7&N,+.% '3(7,% OCAI%
3/).(&)&)6%&.,9'%('%\1&1%:/0%2,,7%',<0(7%.,)'&/)i]=%
b/).+/7'% ;,+,% +,3+0&.,1%()1% .,'.,1%&)% .4,% 3(2,.,+&(% /2% (% '5/+.'%370*% ()1% ;,+,%
,P0(77:%.,'.,1% .4+,,% .&9,'8% ;4&7,% ,)[/:&)6% .4,&+% )/+9(7% ,-,)&)6% '/3&(7%
&).,+(3.&/)'=%
%
Laboratory+assessments+
j)% ,(34% /2% .4,% ('',''9,).'8% *7//1% ;('% 1+(;)% *:% -,)&50)3.0+,% &)./% ()% L"?>C
3/(.,1% 3/77,3.&/)% .0*,=% X7('9(% ;('% ,<.+(3.,1% ;&.4&)% OA% 9&)0.,'% /2% .4,% *7//1%
3/77,3.&/)%*:%Vkb%3,).+&206(.&/)%(.%G%6%2/+%OT%9&)0.,'%()1%&99,1&(.,7:%'./+,1%(.%C
GTk=%J&.4&)%GV%4/0+'8%57('9(%'(957,'%;,+,%.+()'2,++,1%./%(%CWTkb%2+,,Q,+%;4,+,%
.4,:%;,+,%'./+,1%0).&7%(''(:,1=%
b/+.&'/7%Ebja?I8% *,.(% ,)1/+54&)'%E*CLd"I8% ()()1(9&1,% E>L>I% ()1% GC
(+(34&1/)/:767:3,+/7% EGC>KI% ;,+,% 9,('0+,1% &)% 1057&3(.,% % *:% % L)Q:9,CR&)N,1%
D990)/'/+*,).%>''(:%ELRD#>I%N&.'%1,-,7/5,1%*:%b7/01Cb7/),%E_#>I%(33/+1&)6%./%
.4,%9()02(3.0+,+l'%&)'.+03.&/)'=%
#(957,'%2+/9%.4,%.4+,,%6+/05'%;,+,%()(7:Q,1%&)%+()1/9&Q,1%',P0,)3,%;&.4%(77%
.4+,,%'(957,'%/2% (% '&)67,%'0*[,3.%/)%.4,%'(9,%57(.,% ()1% ()%,P0(7%1&'.+&*0.&/)%/2%
.4,%.4+,,% '0*[,3.% 6+/05'%5,+% 57(.,=% #(957,'%;&.4% (% 3/,22&3&,).%/2% -(+&(.&/)% EbeI%
mGTU%;,+,%,<3701,1%2+/9%'.(.&'.&3(7%()(7:','=%
%
Statistical+analyses+
!(',7&),% 1&22,+,)3,'% &)% 1,9/6+(54&3% -(+&(*7,'% *,.;,,)% .4,% .4+,,% 6+/05'% ;,+,%
,<(9&),1% *:% /),C;(:% >dje>8% 2/77/;,1% *:% 5/'.4/3% ?0N,:% M#"% .,'.% 2/+%
3/).&)0/0'% -(+&(*7,'% ()1% *:% X,(+'/)% b/).&)6,)3:% >)(7:','% 2/+% )/)C5(+(9,.+&3%
-(+&(*7,'=%
R/)6&.01&)(7% 1(.(% ;,+,% '3+0.&)&Q,1% *:% 0',% /2% R&),(+% $&<,1% $/1,7% ER$$I%
()(7:','% ;&.4% .4,% *&/7/6&3(7% 9(+N,+'% ('% /0.3/9,% -(+&(*7,'=% !(',1% /)% .4,%
R/67&N,7&4//1%ECGRRI%-(70,8%;,%2&..,1%(%9/1,7%.4(.%':'.,9(.&3(77:%&)3701,1%'0*[,3.%
D"% ()1% 57(.,% )09*,+% ('% +()1/9% &).,+3,5.'=% J,% ':'.,9(.&3(77:% &)3701,1% 6+/058%
.&9,% ()1% 6+/05n.&9,% &).,+(3.&/)% &)% .4,% 9/1,7% ('% 2&<,1% 2(3./+'%2/+% ,(34%
*&/9(+N,+=%>11&.&/)(77:8%./%3/).+/7%2/+%.4,%,22,3.'%/2%.4,%1,9/6+(54&3'8%;,%(11,1%
(6,8% !$D% ()1% !"D% ('% (11&.&/)(7% 2&<,1% 2(3./+% &)% .4,%(1[0'.,1% 9/1,7'=% j)7:% 2&<,1%
2(3./+'% '&6)&2&3().7:% 3/).+&*0.&)6% ./% .4,% 9/1,7% ;,+,% 9(&).(&),1=% ?4,% /0.50.'%
2+/9% .4,% 9&<,1% 9/1,7'% ()(7:','% (+,% +,5/+.,1% ('% lBC+(.&/% E"BIo% 5C-(70,l=% %?4,%
&)&.&(7% R$$% &)3701,% (77% 6+/05'=% D)% 3(',% /2% (% '&6)&2&3().% 6+/05n.&9,% &).,+(3.&/)8%
2/77/;% 05% R$$% ()(7:','% ,<57/+,1% .4,% 6+/05n.&9,% &).,+(3.&/)% &)% '0*9&''&-,'%
-,+'0'%3/).+/7'%/)%/),%4()1%()1%1/9&)().'%./%3/).+/7'%/)%.4,%/.4,+%./%,<57/+,%
;4&34%6+/05%1&22,+,)3,'% 3/).+&*0.,1%./%.4,%'&6)&2&3()3,%/2%.4,% &).,+(3.&/)% &)%.4,%
&)&.&(7%9/1,7=%B&)(77:8% ;4,)%'&6)&2&3().%.&9,%/+%6+/05n.&9,% ,22,3.'%;,+,%2/0)1%&)%
.4&'% 7(..,+% ()(7:'&'8% 5/'.C4/3% ()(7:'&'% ;&.4% ?0N,:% M#"% 3/++,3.&/)% 2/+% 907.&57,%
.,'.&)6%;('%3(++&,1%/0.%./%3/95(+,%.4,%/0.3/9,%*,.;,,)%.4,%.&9,%5/&).'%;&.4&)%
.4,%',5(+(.,%6+/05'=%
d/+9(7&.:% /2% /0.3/9,% -(+&(*7,'% ;('% ,-(70(.,1=% D)% /+1,+% ./% 34,3N% .4,%
(''095.&/)'% 2/+% .4,% 7&),(+% 9/1,7% ()(7:','8% ;,% 34,3N,1% .4,% )/+9(7&.:% /2% .4,%
+,'&10(7'%()1% 4/9/'3,1('.&3&.:% /2%-(+&()3,% 2/+% ,(34% /2%.4,% *&/9(+N,+'=% >L>8%GC
>K%()1%bja%;,+,%7/6C.+()'2/+9,1%./%/*.(&)%)/+9(7%1&'.+&*0.&/)=%M/9/6,),&.:%/2%
-(+&()3,'%;('%('','',1%*:%0',%/2%.4,%R,-,),l'%.,'.=%
%
Results:!
Subjects+
",9/6+(54&3% &)2/+9(.&/)% &'% 5+,',).,1% &)% ?(*7,% O=% J4,+,('% @A% 3/057,'% ;,+,%
&)3701,1%&)%.4,%'.01:8%*7//1%'(957,'%/2%O%1/9&)().%()1%G%'0*9&''&-,'%3/071%)/.%
*,%()(7:',18%+,'07.&)6%&)%.4,%&)370'&/)%/2%@V%1/9&)().'%()1%@@%'0*9&''&-,'%&)%.4,%
2&)(7% ()(7:','=% #&6)&2&3().% (6,% ()1% 6,)1,+% ,22,3.'% ;,+,% 5+,',).8% ('% ;,77% ('% ()%
/-,+(77% 6+/05% ,22,3.% 2/+% !$D=% X/'.C4/3%?0N,:C^+(9,+% M#"% ()(7:','% +,-,(7,1% (%
'&6)&2&3().% (6,% 1&22,+,)3,% *,.;,,)% 1/9&)().'% ()1% 3/).+/7'% E5F=TTGVI8% ;&.4%
1/9&)().'%*,&)6%'7&64.7:%/71,+8% ;4,+,('% '0*9&''&-,'% 1&1% )/.% '&6)&2&3().7:% 1&22,+%
2+/9%,&.4,+%6+/05=%>'% 2/+% .4,% !$D% 1&22,+,)3,8%?0N,:%M#"%2/77/;%05%()(7:','%1&1%
)/.% +,-,(7% ():% '&6)&2&3().% 1&22,+,)3,% *,.;,,)% 6+/05'=% K,)1,+% 1&22,+,)3,'% ;,+,%
(..+&*0.(*7,% ./% .4,% 2(3.% .4(.% 9/'.% 1/9&)().% 5(+.&3&5().'% ;,+,% 9(7,% ESWUI%
;4,+,('%'0*9&''&-,'%.,)1,1%./%*,%2,9(7,%EH@UI=%$,()%10+(.&/)%/2%.4,%57(:%;('%
A@=A%9&)0.,'%EpgC%OV=S%9&)0.,'I=%#,)'/+:%1,5+&-(.&/)%57(:,1%(%9&)/+%+/7,%&)%A%/2%
.4,%&).,+(3.&/)'8%()1%(%9([/+%+/7,%&)%()%(11&.&/)(7%A%/2%.4,9=%
%
%%% % % CCDd#La?%?>!RL%O%>!j_?%MLaL%C%C%
%
Biological+markers+in+dominants,+submissives+and+controls+
b/)3,).+(.&/)'%/2%.4,%2/0+%*&/9(+N,+'%/-,+%.4,%.4+,,%.&9,%5/&).'%E?O8%?G%()1%?@I%
&)%.4,%.4+,,%'0*[,3.%6+/05'%(+,%5+,',).,1%&)%B&60+,%O=%
?4,%.&9,n6+/05%&).,+(3.&/)%;('%.4,%/)7:%5+,1&3./+%2/+%3/+.&'/7%7,-,7'%&)%.4,%R$$%
EBFA=VT%EV8OOOIo%5F=TTTAI=% d,&.4,+%(6,8%6,)1,+8%!$D%)/+%!"DC'3/+,'%3/).+&*0.,1%
./%.4,%9/1,78%/+%3/071%(33/0).% 2/+%():%/2%.4,',% ,22,3.'=%B/77/;C05%R$$%()(7:','%
*,.;,,)%1/9&)().'%()1% 3/).+/7'%/)%/),%4()18% ()1%'0*9&''&-,'%()1%3/).+/7'%/)%
.4,% /.4,+% +,-,(7,1% .4(.% .4&'% .&9,n6+/05% &).,+(3.&/)% ;('% (..+&*0.(*7,% ./%(%
'&6)&2&3().% .&9,n6+/05% &).,+(3.&/)% *,.;,,)% '0*9&''&-,'% ()1% 3/).+/7'% EBFA=@Ao%
5F=TTSSI=%D)%3/).+('.8%)/%'&6)&2&3().%.&9,n6+/05%&).,+(3.&/)'%;,+,%5+,',).%;4,)%
3/95(+&)6% 1/9&)().'% ()1% 3/).+/7'=% X(&+;&',% 3/95(+&'/)% /2% .4,% 3/+.&'/7% 7,-,7'%
*,.;,,)% .4,% 1&22,+,).% .&9,% 5/&).'% E;&.4% ?0N,:% M#"% 3/++,3.&/)I% ;&.4&)% .4,%
'0*9&''&-,% 6+/05% +,-,(7,1% .4(.% 3/95(+,1% ./% *(',7&),8% % ?G% E.C+(.&/F% C@=WAo%
5F=TTOOI% ()1% ?@% E.C+(.&/% F% CG=`Ao% 5F=TO@WI% 3/+.&'/7% 7,-,7'% ;,+,% '&6)&2&3().7:%
&)3+,(',1=%d/%'034%.&9,%,22,3.'%;,+,%2/0)1%&)%.4,%.;/%/.4,+%6+/05'=%
d/% '&6)&2&3().% .&9,8% 6+/05% /+% .&9,n6+/05% &).,+(3.&/)'% ;,+,% 2/0)1% 2/+% *,.(C
,)1/+54&)=%%
%
>L>% 3/)3,).+(.&/)'% ;,+,% 5+,1&3.,1% *:% (% '&6)&2&3().% .&9,n6+/05% ,22,3.% EBFG=VWo%
5F=TVWSI%()1%/2%3/+.&'/7%3/)3,).+(.&/)'%EBFOTT=OVo%5q=TTTOI=%>6(&)8%)/),%/2%.4,%
/.4,+% 3/-(+&(.,'% 3/).+&*0.,1% ./% .4,% 9/1,7=% >6(&)8% .4,% 6+/05n.&9,% &).,+(3.&/)%
,22,3.% ;('% ,<57(&),1% *:% .4,% &).,+(3.&/)% *,.;,,)% '0*9&''&-,'% ()1% 3/).+/7'%
EBF@=AGo% 5F=T@VVI=% X/'.4/3% ()(7:'&'% ;&.4% %?0N,:% M#"% 3/++,3.&/)% ;&.4&)% .4,%
'0*9&''&-,%6+/05%+,-,(7,1%(%'&6)&2&3().%1&22,+,)3,%&)%>L>%3/)3,).+(.&/)%*,.;,,)%
*(',7&),% ()1% ?@% E.FG=H@o% 5F=TGOWI% ;4,+,('% .4,% 3/95(+&'/)% *,.;,,)% *(',7&),%
()1%?G%/)7:%'4/;,1%(%.+,)1%./;(+1'%'&6)&2&3()3,%E.FG=OGo%5F=T`GAI=%
b/)3,).+(.&/)'% /2% L)1/3())(*&)/&1% GC>K% ;,+,% 5+,1&3.,1% *:% 3/+.&'/7% 7,-,7'%
EBFWO8HHo%5q=TTTOI%()1%9(+6&)(77:%'&6)&2&3().7:%*:% 6+/05%EBFG=AHo%5F=TWG`I=%d/%
.&9,n6+/05% &).,+(3.&/)'% ;,+,% 2/0)1=% B/77/;C05% ?0N,:% M#"% ()(7:','% &)% .4,%
'0*9&''&-,'%'4/;,1%(%*/+1,+7&),%'&6)&2&3().%1&22,+,)3,%*,.;,,)%*(',7&),%()1%?@%
E.FG=@So%5F=TAHTI8%'&9&7(+%./%.4,%2&)1&)6'%;&.4%>L>=%
"/9&)().'%()1%3/).+/7'%1&1%)/.%1&22,+%/)%,&.4,+%>L>%/+%GC>K=%
%
Impact+of+sexual+experience+of+the+interaction+
X(+.&3&5().'%+(.,1%.4,%,<5,+&,)3,1%',<0(7%.,)'&/)%/2%.4,%&).,+(3.&/)=%B&2.,,)%/0.%
/2% @V% 1/9&)().'% ()1% OH% /0.% /2% @@% '0*9&''&-,'% +(.,1% .4,% ,<5,+&,)3,% ./% 4(-,% (.%
7,('.%'/9,%',<0(7% .,)'&/)=%D)%.4,%1/9&)().% 6+/058%\',<0(7%.,)'&/)]C'3/+,'%E9,()%
'3/+,% @=O% EO=AIo% +()6,h% OCSI%3/++,7(.,1% ./% >L>C3/)3,).+(.&/)'% E#5,(+9()]'%
+4/F=GAGo%5F=TO@I%()1%GC>K%3/)3,).+(.&/)'% E#5,(+9()]'% +4/F=GVAo% 5F=TOVI8%*0.%
)/%3/++,7(.&/)'%;,+,%2/0)1%;&.4%():%/2%.4,%*&/7/6&3(7%9,('0+,'%&)%.4,%'0*9&''&-,%
6+/05%E9,()%'3/+,%',<0(7%.,)'.&/)h%@=G%EO=@Io%+()6,h%OCSI=%%
>% ./.(7% /2% S% /0.% /2% @@% '0*9&''&-,'% +,5/+.,1% +,(34&)6% ()% /+6('9% 10+&)6% .4,%
&).,+(3.&/)=%?4,%-(+&(*7,%E5+,',)3,%/2%/+6('9%:,'g)/I%,).,+,1%.4,%9/1,78%*0.%1&1%
)/.%4(-,%():%5+,1&3.&-,%-(70,%./;(+1'%():%/2%.4,%*&/7/6&3(7%-(+&(*7,'=%
%
Impact+of+the+type+of+BDSM+interaction+in+dominants+and+submissives+
D)% 2/77/;% 05% ()(7:','8% .4,% &95(3.% /2% .:5,% /2% 57(:% /)% .4,',% *&/9(+N,+'% ;('%
,-(70(.,1%2/+%,(34%6+/05%',5(+(.,7:=%"&34/./9/0'%-(+&(*7,'%;,+,%3+,(.,1%*(',1%
/)%.4,%/*',+-,+'%'3/+,'%./% 1,.,+9&),% ;4,.4,+% 5(&)% 57(:% ;('%5+,',).%E)FGAI%/+%
)/.%E)FWI8%()1%./%;4(.%,<.,).%.4,%/*',+-,+%1,,9,1%.4,%&).,+(3.&/)%./%,)3/95(''%
5/;,+%57(:%E)FOGI%/+%)/.%E)FO`I=%
"/9&)().'% ,)6(6,1% &)% 5/;,+% 57(:% 1&1% 1&'57(:% 4&64,+% >L>% EBFA=OHWo% 5F=T@TGI%%
()1%4&64,+%GC>K%EBFV=AO%E@TIo%5FT=TVGOI%7,-,7'%-,+'0'%.4/',% ;4/%1&1%)/.=%d/),%
/2%.4,%5+,-&/0'7:%9,).&/),1%3/-(+&(.,'%'&6)&2&3().7:%3/).+&*0.,1%./%.4,',%9/1,7'=%
b/+.&'/7%()1%*,.(C,)1/+54&)'%;,+,%)/.%(22,3.,1%*:%5/;,+%57(:%&)%1/9&)().'=%
J4,.4,+%5(&)%57(:%;('%&957,9,).,1%/+%)/.%1&1%)/.%(22,3.%():%/2%.4,%*&/9(+N,+'%
&)%1/9&)().'=%
D)% '0*9&''&-,'8% 5/;,+% 57(:% 1&1% )/.% &95(3.% ():% /2% .4,% *&/7/6&3(7% 9(+N,+'=%
M/;,-,+% .4,% 5+,',)3,% /2% 5(&)% 57(:% ;('% (''/3&(.,1% ;&.4% 4&64,+% 7,-,7'% /2% GC>K%
E.FG=GS% E@AIo% 5FT=T@TI8% ;4&34% ;('% ,<57(&),1% *:% (% .+,)1% ./;(+1'% '&6)&2&3().%
1&22,+,)3,% *,.;,,)% ?O% ()1% ?G% E.FCO8HG% EASIo% 5FT=T`GI=% >7.4/064% .4,+,% ;('% (%
;,(N% .+,)1% ./;(+1'% ()% ,22,3.% 2/+% 5(&)% 57(:% /)% >L>% 3/)3,).+(.&/)'% &)%
'0*9&''&-,'8%.4&'%,22,3.%;('%)/.%'&6)&2&3().%E.FO8VS%E@AIo% 5FT=OAVI=%X(&)%57(:%1&1%
)/.%(22,3.%*,.(C,)1/+54&)'%/+%3/+.&'/7%7,-,7'%&)%'0*9&''&-,'=%
%
Discussion!
Main+findings+
J,% &)-,'.&6(.,1% .4,% ,22,3.'% /2% ()% (3.0(7% !"#$C/+&,).,1% &).,+(3.&/)% *,.;,,)% (%
'0*9&''&-,% ()1% (% 1/9&)().% 5(+.),+% /)% .4,% *&/9(+N,+'% +,7(.,1% ./% +,;(+1%
E,)1/+54&)8%GC>K8%>L>I%()1%'.+,''%E3/+.&'/7I=%B&+'.%/2%(778%;,%',,%.4(.8%3/95(+,1%
./% )/)C!"#$% &).,+,'.,1%3/).+/7'8%3/+.&'/7% 7,-,7'%;,+,% '&6)&2&3().7:% ,7,-(.,1% (.%
*(',7&),%&)%'0*9&''&-,'8%*0.%)/.%1/9&)().'=% #0*9&''&-,'% ,<5,+&,)3,1% &)3+,(',1%
3/+.&'/7%7,-,7'%('%(%+,'07.%/2%.4,%57(:=%$/+,/-,+8%'/9,%,22,3.'%;,+,%(7'/%2/0)1%/)%
.4,% +,;(+1C+,7(.,1% *&/9(+N,+'h% ;4,+,('% )/% '&6)&2&3().% 34()6,'% ;,+,% 2/0)1% &)%
*,.(C,)1/+54&)'8% */.4% ,)1/3())(*&)/&1'% % ;,+,% &95(3.,1% &)% .4,% '0*9&''&-,'%
3/95(+,1% ./% 3/).+/7'% ('% (% +,'07.% /2% ()% &).,+(3.&/)% ;&.4% .4,&+% 5(+.),+8% ()% ,22,3.%
.4(.% 3/071% )/.% *,% 2/0)1% &)% .4,&+% 1/9&)().% 3/0).,+5(+.'=% b/+.&'/7% 7,-,7'% (7'/%
'&6)&2&3().7:%&)270,)3,1%,)1/3())(*&)/&1%7,-,7'=%
%
b/+.&'/7% 7,-,7'% &)% '0*9&''&-,'% &)3+,(',1% 10+&)6% .4,% 57(:8% ;4&34% 9(:% 4(-,%
+,'07.,1% 2+/9% .4,% 9,).(7% ()1% 54:'&3(7% '.&907(.&/)% 10+&)6% .4,% &).,+(3.&/)'%
*,.;,,)% */.4% 5(+.),+'% EO`I=% ?4,',%2&)1&)6'8% ;4&34% (+,% &)% 7&),% ;&.4% ,(+7&,+%
2&)1&)6'% /2% #(6(+&)% ()1% 3/77,(60,'% EOOI% 3/)2&+9% /0+% 4:5/.4,'&'% .4(.% (% !"#$%
&).,+(3.&/)'% ',,9'% ./% ,7&3&.% (% '.+,''% +,'5/)',% 2+/9% .4,% */1:8% 9,('0+,1% *:% .4,%
&)3+,(',1% 3/+.&'/7% 7,-,7'=% >11&.&/)(77:8% 5,+2/+9&)6% ('% (% '0*9&''&-,% *,2/+,% ()%
(01&,)3,%9(:%,P0(77:%4(-,%3/).+&*0.,1% ./% .4,',%3/+.&'/7%&)3+,(','=%#(6(+&)%,.%(7%
EOOI% 1,9/)'.+(.,1% &)3+,(','% /2% 3/+.&'/7% &)% '0*9&''&-,'% GT% 9&)0.,'% (2.,+% 57(:8%
;4,+,('%.4,',%7,-,7'%)/+9(7&Q,1%(2.,+%VT%9&)0.,'=%?4&'%&'%&)%7&),%;&.4%/0+%'.01:8%
&)% ;4&34% 2&)(7% ('',''9,).% ;('% /)7:% OACGT% 9&)0.,'% (2.,+% .4,% &).,+(3.&/)8% ;4&34%
'.&77%'4/;,1%&)3+,(',1% 3/+.&'/7%7,-,7'=%D.%3()% *,%(''09,1%.4(.%3/+.&'/7% 7,-,7'%9(:%
4(-,%1,3+,(',1%7(.,+%/)8%*0.%.4,%7(3N%/2%'034%()%('',''9,).%&'%(%7&9&.(.&/)%&)%/0+%
'.01:=%
%
b4()6,'%&)103,1% *:% .4,% &).,+(3.&/)%&)% ,)1/3())(*&)/&1'% >L>% ()1% GC>K% ;,+,%
3/)'&'.,).7:% 5+,',).% &)% '0*9&''&-,'8% *0.% )/.% &)% 1/9&)().'% /+% 3/).+/7'=% >'% ;,%
3/).+/77,1% 2/+% .4,% &95(3.% /2% '/3&(7% &).,+(3.&/)'% &)% 6,),+(78% .4,% ,22,3.'% 3/071%
'5,3&2&3(77:%*,%3/).+&*0.,1%./%!"#$%57(:=%D)%3/).+('.8%)/%6+/05%1&22,+,)3,'%;,+,%
2/0)1% 2/+% *,.(C,)1/+54&)=% j2% )/.,8% *,.(C,)1/+54&)% 1/,'% )/.% 5(''% .4,% *7//1C
*+(&)C*(++&,+%E!!!I%*:%&.',728%()1%&'%('%'034%)/.%()%&1,(7%*&/9(+N,+%2/+%9,('0+&)6%
*+(&)%&)103,1%34()6,'8%,'5,3&(77:%;4,)%('','',1%5,+&54,+(77:=%%
L)1/3())(*&)/&1'8% ()1%&)% 5(+.&307(+% >L>% ()1% GC>K8% 4(-,% '4/;)% ./% *,% 9/+,%
+,5+,',).(.&-,%2/+%9,('0+&)6%57,('0+,%&)%+,3,).%'.01&,'%('%.4,:%1/%5(''%.4,%!!!%
()1%57(:% (% '&6)&2&3().% +/7,% &)% ',<0(7% 57,('0+,% EOAI% ()1% ',<0(7% 9/.&-(.&/)% EOSI=%
L)1/3())(*&)/&1'% *&)1% E(9/)6'.% /.4,+% .(+6,.'I% /)% .4,% b!O% +,3,5./+% Eb!OaI%
9,9*,+% /2% .4,% KC5+/.,&)% 3/057,1% +,3,5./+% 2(9&7:=% ?4,% 9([/+&.:% /2% b!Oa'%
,<5+,'',1% &)% .4,% 409()% */1:% (+,% 7/3(.,1% &)% .4,% *+(&)8% ()1% (+,% '.+/)67:%
+,5+,',).,1% &)% .4,% e,).+(7% ?,69,).(7% >+,(8% ;4&34% 5+/[,3.'% 1/5(9&),+6&3%
5(.4;(:'% '.&907(.&)6% .4,% )037,0'% (3309*,)'8% (% 3/+,% ('5,3.% /2% .4,% +,;(+1%
':'.,9=%>'% '0348%>L>%()1%GC>K%4(-,%%(%+,607(.&)6%+/7,%&)%1/5(9&),+6&3%':)(5.&3%
.+()'9&''&/)%EGTI=%
j0+% 2&)1&)6'% '066,'.% .4(.% '0*9&''&-,'% ,)6(6&)6% &)% !"#$% 57(:% 1,+&-,% 57,('0+,%
2+/9%.4,',%&).,+(3.&/)'=% ?4&'% &'% &)%7&),%;&.4% +,3,).% ()&9(7% %EOS8%GOI% ()1% 409()%
EOHI% '.01&,'% 7&)N&)6% ,)1/3())(*&)/&1% 7,-,7'% ./% ',<0(7% (3.&-&.:% ()1% 57,('0+,8% ('%
;,77%('%./%',<0(7%9/.&-(.&/)%()1%5(+.),+%5+,2,+,)3,%EGGI=%%?4,%'.+/)6%(''/3&(.&/)%
;&.4% 3/+.&'/7% 7,-,7'% (7'/% (+60,'% 2/+% .4,% 57,('0+,C&)103&)6% &95(3.% /2% .4,% '.+,''%
,<5,+&,)3,1%*:% .4,% !"#$% &).,+(3.&/)8% ;4&34% '066,'.'% ()% &95(3.% /2% .4,% .4+&77% /2%
!"#$=%D.% '4/071% *,% )/.,1% .4(.% &)% '0*9&''&-,'8% .4,% 57('9(% 7,-,7'% /2% )/),% /2% .4,%
*&/9(+N,+'%;('%3/++,7(.,1%./%.4,%'0*[,3.&-,7:%,<5,+&,)3,1%',<0(7%.,)'&/)=%?4&'%&'%
&)% 7&),% ;&.4% .4,% 2(3.% .4(.% &)% '0*9&''&-,'8% .4,',% 34()6,'% &)% +,;(+1C+,7(.,1%
*&/9(+N,+'% ;,+,% +,7(.,1% ./% 5(&)% 57(:8% +(.4,+% .4()% ./% 5/;,+% 57(:=% ?4&'% 9&++/+'%
2&)1&)6'%2+/9%(%'.01:% /2% ",2+&)%()1%3/77,(60,'%E`I%;4&34%1,9/)'.+(.,1% .4(.% .4,%
'0*[,3.&-,7:% +,5/+.,1% (9/0).% /2% 5,+3,&-,1% 57,('0+,% '.+/)67:% 3/++,7(.,1% ./% .4,%
&).,)'&.:% /2% 5(&)% ,-/N,1% *:% .4,% 1/9&)().% ('% ;,77% ('% ;&.4% .4,% )09*,+% /2% */1:%
+,6&/)'%.4(.% ;,+,% '.&907(.,1=% "/9&)().'%('% (% 6+/05%1&1% )/.%1&'57(:% 34()6,'% &)%
+,;(+1C+,7(.,1% *&/9(+N,+'=% M/;,-,+8% 3/)',P0,).% 5/'.C4/3% ()(7:','% +,-,(7,1%
.4(.%.4/',%1/9&)().'% ;4/%&).+/103,1%9/+,%5/;,+%1:)(9&3'% &)%.4,%&).,+(3.&/)'%
4(1% '&6)&2&3().7:% 4&64,+% ,)1/3())(*&)/&1% 7,-,7'8% 3/95(+,1% ./% .4,&+% 5,,+'% ;4/%
1&1% )/.=% ?4&'% 6&-,'% 0'% ()% &).,+,'.&)6% -&,;% 05/)% .4,% 1:)(9&3'% ;&.4&)% (% !"#$%
&).,+(3.&/)=%D.%&'% (% 37,(+% &)1&3(.&/)% .4(.%(%!"#$% &).,+(3.&/)% &)% 6,),+(78% ()1%5(&)%
,<5,+&,)3,%;&.4&)% .4&'% &).,+(3.&/)% '5,3&2&3(77:8% ,7&3&.'% (% *&/7/6&3(7% 57,('0+,%
+,'5/)',%&)%.4,%'0*9&''&-,%5(+.:=%"/9&)().'8%/)%.4,%/.4,+%4()18%',,9%./%1,+&-,%
9/+,%57,('0+,%2+/9%.4,%('5,3.%/2%5/;,+%57(:%()1%.4,%3/).+/7%.4,:%4(-,%/-,+%.4,%
'0*9&''&-,%5,+'/)=%?4,% 2(3.%.4(.%.4,',%&).,+(3.&/)'%.+&66,+%9,34()&'9'% .4(.%(+,%
'&9&7(+% ./% 5+/3,'','% &)-/7-,1% &)% ',<0(7% (+/0'(7% ()1% ,)[/:9,).'% &'% +,27,3.,1% &)%
&).,+-&,;C*(',1% '.01&,'% &)% ;4&34% !"#$% 5+(3.&.&/),+'% &)1&3(.,% .4(.% .4,&+% !"#$%
,<5,+&,)3,'% (+,% 9/'.7:% ',<0(7% &)% )(.0+,8% ()1% &)1&3(.,% .4(.% !"#$% 57(:% &'%
*&1&+,3.&/)(77:% (''/3&(.,1% ;&.4% ,9/.&/)(7% 3/)),3.&/)% ()1% 7/)6C.,+9% ',<0(7%
&).,+(3.&/)'%EG@I=%%
D).,+,'.&)67:8% '/9,% 5+(3.&.&/),+'% 4(-,% 1,'3+&*,1% .4,&+% !"#$% 5+,2,+,)3,% ('% ()%
(11&3.&/)8% ()1% '/9,.&9,'% 9,).&/),1% (% +0'4% /+% \4&64]% 10+&)6% !"#$C/+&,).,1%
&).,+(3.&/)'% EGVI=% j2% )/.,8% .4,% ,)1/3())(*&)/&1% ':'.,9% 4('% +,5,(.,17:% *,,)%
&957&3(.,1% &)% .4,% ),0+/*&/7/6&3(7% 5+/3,'','% 0)1,+7:&)6% /.4,+% (11&3.&/)'8%
&)3701&)6%'0*'.()3,%0',%1&'/+1,+%EGAI=%
B0+.4,+%+,',(+34%7//N&)6%(.%1&22,+,).% ('5,3.'% /2% .4,%-(+&,1%!"#$%2&,71%()1%.4,&+%
&)270,)3,%/)%.4,%*/1:%;/071%*,%),3,''(+:%./%1,,5,)%/0+%0)1,+'.()1&)6%/2%.4,',%
+,'07.'=%%
!
Limitations+
?4,+,%(+,%',-,+(7%7&9&.(.&/)'%;/+.4%9,).&/)&)6=%B&+'.7:8%(7.4/064%/0+%'(957,%'&Q,%
&'% '&6)&2&3().7:% 4&64,+% .4()% '&9&7(+% +,',(+34%&)% .4,% 5('.8% .4&'% '.01:% /)7:% 4('% (%
9/1,+(.,%(9/0).%/2%5(+.&3&5().'8%10,%./%.4,%',)'&.&-,%)(.0+,%/2%.4,%&).,+(3.&/)'=%%%
#,3/)17:8% /*',+-(.&/)% *&('% 9(:% *,% 5+,',).% '&)3,% ;,% 1/% )/.% N)/;% 4/;%
/*',+-(.&/)% *:% .4,% +,',(+34,+'% 9(:% 4(-,% &95(3.,1% .4,%)(.0+,% /2% .4,%!"#$%
&).,+(3.&/)'8% ('% ;,77% ('% .4,% '.+,''% 7,-,7'=% ?4&'% *&('% ;&77% *,% 7&9&.,18% '&)3,% .4,%
&).,+(3.&/)'%.(N,%57(3,%&)%(%50*7&3%370*% ;4,+,% 9/'.% /2% .4,% 5(+.&3&5().'%(+,%0',1%
./%E)/)C'3&,).&2&3I%/*',+-(.&/)'%*:%/.4,+%370*%9,9*,+'=% >11&.&/)(77:8% &).,++(.,+%
*&('%9(:%4(-,%&95(3.,1%+,'07.'%'&)3,%.4,+,%;,+,%907.&57,%/*',+-,+'%.4+/064/0.%
.4,%'.01:8%.4/064%.4&'%;('%9&)&9&Q,1%*:%1&'30''&)6%.4,%9,.4/1%*,2/+,4()1%()1%
(2.,+;(+1'=%#/9,%&).,+(3.&/)'%;,+,%;&.),'',1%*:%.;/%/*',+-,+'%'&907.(),/0'7:8%
;4&34%4,75,1%9&)&9&',%&).,++(.,+%-(+&(*&7&.:=%
%
?4&+17:8% 5(+.&3&5().'% ;,+,%+,3+0&.,1% .4+/064% .4,% !"#$% 370*%;4,+,% .4,% 1(.(%
3/77,3.&/)%;('% 1/),% ('% ;,77% ('%.4+/064%B7,9&'4% 3/990)&.&,'% /)% B,.7&2,% E&=,=%.4,%
7(+6,'.%'/3&(7%;,*'&.,%2/+%.4,%!"#$%3/990)&.:I8%;4&34%9&64.%7,(1%./%(%',7,3.&/)%
*&('=% J,% N)/;% 2+/9% 5+,-&/0'% +,',(+34% EVI% .4(.% WAU% /2% !"#$% /+&,).,1% 5,/57,%
/)7:%57(:%;&.4&)%.4,%3/)2&),'%/2%.4,&+%4/9,8%;4&34%9,()'%(%7(+6,%'(957,%/2%!"#$%
5+(3.&.&/),+'%(+,%*:%1,2&)&.&/)%)/.%&)3701,1%&)%.4&'%'.01:=%$/+,/-,+8%(7.4/064%.4&'%
)/.&/)%'.&77%),,1'%'3+0.&):8%307.0+(7%1&22,+,)3,'%9(:%,<&'.%*,.;,,)%1&22,+,).%370*'%
()1%)(.&/)(7&.&,'%('%./%.4,%N&)1% /2%&).,+(3.&/)'%.4(.%(+,%1/),%(.%'&.,%EG8%GSI=% ?4&'%
3/071% 9,()% .4(.% .4,% '(957,% &)3701,1% &)% /0+% '.01:% 9&64.% )/.% *,% 2077:%
+,5+,',).(.&-,% 2/+% .4,% *+/(1,+% !"#$% 5/507(.&/)=%#.01:&)6% ,<5,+&,)3,1% !"#$%
5(+.&3&5().'% '034% ('% .4,% /),'% ;4/% (..,)1% .4&'% 370*8% 4/;,-,+8% 1/,'% 4(-,% .4,%
(1-().(6,% .4(.% .4,&+% &).,+(3.&/)'% (+,% *0&7.% /)% .+0'.% ()1% (+,% ,<,30.,1% &)% (% '(2,8%
'(),%()1%3/)',)'0(7%;(:=%%
#0*9&''&-,'% ;,+,% .:5&3(77:% &99/*&7&Q,18% .40'% +,103&)6% .4,% (9/0).% /2% 54:'&3(7%
(3.&-&.:%&)%.4&'%6+/05=%?4,%1/9&)().%6+/05%;&77%4(-,%*,,)%9/+,%(3.&-,%10,%./%.4,%
)(.0+,% /2% .4,&+% (3.&-&.&,'% 10+&)6% 57(:% E,=6=% 27/66&)68% 4&..&)68rI8% ;4,+,('% 3/).+/7'%
1,9/)'.+(.,1%7&..7,%54:'&3(7%(3.&-&.:8%(7.4/064%.4&'%;('%)/.%/*[,3.&2&,1=%M/;,-,+8%
;,% 1/% )/.% ,<5,3.% .4,',% (3.&-&.:% 1&22,+,)3,'% ./% 4(-,% &)270,)3,1% .4,% +,'07.'8% ('%
4&64,+% (3.&-&.:% +(.,'% (+,% (''/3&(.,1% ;&.4% &)3+,(',1% 57,('0+,% 4/+9/),'% EGHI8%
;4&34% 3/).+('.'% ;&.4% /0+% 2&)1&)6'% .4(.% .4,% 9/'.% &99/*&7,% 6+/05% E&=,=% .4,%
'0*9&''&-,'I%4(1%9/'.%5+/)/0)3,1%&)3+,(','%&)%4/+9/),%7,-,7'=%
d/),.4,7,''8% ;,% 2,,7% 3/)2&1,).8% ('% .4&'% &'% .4,% 2&+'.% 9(&)% '.01:% '0++/0)1&)6% .4&'%
3/).+/-,+'&(7%'0*[,3.8%.4,',%7&9&.(.&/)'%;&77%*,%(11+,'',1%&)%20.0+,%+,',(+34=%%
!
Clinical+implications+
a,',(+34%&)%.4&'%5(+.&307(+%./5&3%,)1,(-/+'%./%'4,1%(% 7&64.% /)% '/9,.4&)6% .4(.% &'%
;&1,7:% 5+(3.&3,1% ()1% :,.% 5//+7:% 0)1,+'.//1=% ?4&'% '.01:% ,22,3.&-,7:% 5+/-&1,'% (%
7&)N%*,.;,,)%*,4(-&/+%.4(.%9():%.4&)N%/2%('%(*,++().%/)%/),%4()18%()1%*&/7/6&3(7%
57,('0+,%,<5,+&,)3,%/)%.4,%/.4,+=%?4&'% 50.'%4:5/.4,','%2+(9&)6% !"#$%5+(3.&3,'%
('% +,5,.&.&/)% 3/9507'&/)% /2% .+(09(% EGWI% /)% .4&)% &3,=% !:% 20+.4,+% ,)4()3&)6% /0+%
0)1,+'.()1&)6%.4,%*&/7/6&3(7%9,34()&'9'%*,4&)1%!"#$%&).,+(3.&/)'%&)%.4&'%;(:8%
;,%4/5,%./%+,7&,-,%'/9,%/2%.4,%'.&69(%.4,',%5+(3.&.&/),+'%'.&77%,)10+,=%
"0,% ./% (% 4&'./+&3(7% 5(.4/7/6&Q(.&/)% /2% !"#$%5+(3.&3,8% &.% &'% '.&77% &)3701,1% &)% .4,%
"&(6)/'.&3% ()1% #.(.&'.&3(7% $()0(7% /2% $,).(7% "&'/+1,+'% A.4% ,1&.&/)% E"#$CAI% ()1%
.4,%D).,+)(.&/)(7%b7(''&2&3(.&/)%/2%"&',(','%OT.4%,1&.&/)%EDb"COTI=%!,3(0',%/2%.4&'8%
!"#$% 5+(3.&.&/),+'% ;&77% 2&)1% &.% 9/+,% 1&22&307.% ./% ',,N% 9,).(7% 4,(7.4% '055/+.8% &)%
2,(+%/2%*,&)6%1&'3+&9&)(.,1%(6(&)'.%2/+%.4,&+%5+/37&-&.&,'=%J,%.4,+,2/+,%,)3/0+(6,%
9,).(7%4,(7.4%5+/2,''&/)(7'%./%7//N%*,:/)1%.4&'%5(+.&307(+%-&,;%5/&).%()1%7,'',)%
.4,% .(*//% (.9/'54,+,% '0++/0)1&)6% !"#$8% '/% .4(.% ():/),% 9(:% +,3,&-,% ,P0(7%
.+,(.9,).8%+,6(+17,''%/2%.4,&+%7&2,'.:7,=%%
%
Conclusion:!
?4,%(2/+,9,).&/),1%+,'07.'%'066,'.%.4(.%5/;,+%57(:%4('%(%7(+6,+%57,('0+,%
3/95/),).%%2/+%1/9&)().'%&)%(%!"#$%&).,+(3.&/)'%.4()%5(&)%57(:=%D)%'0*9&''&-,'8%
&)3+,(',1%'.+,''C+,'5/)','%(+,%',,)%10+&)6%%!"#$%&).,+(3.&/)'%;4&34%3()%*,%
,<57(&),1%*:%(%5/'&.&-,%'.+,''%+,(3.&/)8%*0.%.4,+,%&'%(7'/%(%'&6)&2&3().%57,('0+,%
,<5,+&,)3,=%%?4&'%&'%'055/+.,1%*:%.4,%'.+/)6%(''/3&(.&/)%*,.;,,)%3/+.&'/7%7,-,7'%
()1%,)1/3())(*&)/&1%7,-,7'=%%
L-,)%.4/064%.4&'%&'%/),%/2%.4,%2&+'.%'.01&,'%/2%&.'%N&)18%;,%3()%3/)3701,%.4(.%.4,+,%
&'%(%37,(+%&)1&3(.&/)%2/+%&)3+,(',1%57,('0+,%&)%'0*9&''&-,'%;4,)%7//N&)6%(.%
*&/7/6&3(7%,22,3.'%/2%(%!"#$%&).,+(3.&/)=%B0.0+,%+,',(+34%;&77%*,%),,1,1%./%
20+.4,+%/0+%N)/;7,16,%/)%.4,%*&/7/6&3(7%9,34()&'9'%&)-/7-,1%&)%!"#$%
&).,+(3.&/)'=%%
%
Acknowledgments:!
J,]1% 7&N,% ./% .4()N% efJ% HWgB,.&'4% b70*% HW%2/+% 3//+1&)(.&)6% .4,% &)370'&/)% /2%
!#"$% 3/057,'% ()1% N&)17:% 7,..&)6% 0'% 0',% .4,&+% '5(3,% 2/+% .4,% 1(.(% 3/77,3.&/)=% J,%
(7'/% ;/071% 7&N,% ./% .4()N% X,.,+% L.4,+/'% 2/+% 4&'% 4,75% ()1% ,22/+.'% &)% &)3701&)6%
3/057,'%&)% .4,% '.01:8% ()1%e/79(+% LN,+,)% 2/+% .4,&+%4,75% &)% &)3701&)6%.4,%3/).+/7%
'(957,=%>% '5,3&(7%.4()N'%('%;,77%./%(77%.4,%3/057,'%.4(.%5(+.&3&5(.,1%()1%;,+,%'/%
27,<&*7,%&)%7,..&)6%0'%/*',+-,%()1%()(7:Q,%.4,',%&).&9(.,%&).,+(3.&/)'=%%
%
References:%
O=% b/55,)'%e8%?,)%!+&)N%#8%M0:'%J8%B+()',)%L8%$/++,)'%$=%>%#0+-,:%/)%
!"#$C+,7(.,1%>3.&-&.&,'h%!"#$%L<5,+&,)3,%b/++,7(.,'%;&.4%>6,%/2%B&+'.%
L<5/'0+,8%D).,+,'.%X+/2&7,8%()1%a/7,%D1,).&.:=%s/0+)(7%/2%',<%+,',(+34=%GTO`hOCW=%
L50*%GTO`gTOgGA=%
G=%",%d,,2%d8%b/55,)'%e8%M0:'%J8%$/++,)'%$=%!/)1(6,C"&'3&57&),8%
"/9&)()3,C#0*9&''&/)%()1%#(1/9('/34&'9%E!"#$I%B+/9%()%D).,6+(.&-,%
!&/5':34/'/3&(7%X,+'5,3.&-,h%>%#:'.,9(.&3%a,-&,;=%#,<0(7%9,1&3&),=%GTO`=%L50*%
GTO`gTVgT`=%
@=% s/Q&2N/-(%L8%B7,6+%s=%"/9&)()3,8%'0*9&''&-&.:%E()1%4/9/',<0(7&.:I%&)%
6,),+(7%5/507(.&/)h%.,'.&)6%/2%,-/70.&/)(+:%4:5/.4,'&'%/2%'(1/9('/34&'9%*:%
D).,+),.C.+(5C9,.4/1=%d,0+/%,)1/3+&)/7/6:%7,..,+'=%GTTSoGHESIhHOOCW=%L50*%
GTTSgOGgGS=%
V=%M/7-/,.%R8%M0:'%J8%b/55,)'%e8%#,,0;'%s8%K/,.4(7'%^8%$/++,)'%$=%B&2.:%
#4(1,'%/2%!,76&()%K+(:h%?4,%X+,-(7,)3,%/2%!"#$Ca,7(.,1%B().('&,'%()1%>3.&-&.&,'%
&)%.4,%K,),+(7%X/507(.&/)=%?4,%[/0+)(7%/2%',<0(7%9,1&3&),=%GTOHoOVE`IhOOAGC`=%
L50*%GTOHgTWgTH=%
A=%X&.(6/+(%"=%d/%X(&)8%d/%K(&)ih%?4,+(5,0.&3%()1%a,7(.&/)(7%!,),2&.'%/2%
#0*'5(3,%&)%!"#$%b/).,<.'=%s/0+)(7%/2%X/'&.&-,%#,<0(7&.:%GTOHo@hVVCAV=%
S=%!/,3N,+%M8%#5+,)6,+%?8%#5&7N,+%$L8%M,)+&N',)%K8%^/55,)4/,2,+%$8%
J(6),+%^s8%,.%(7=%?4,%+0)),+l'%4&64h%/5&/&1,+6&3%9,34()&'9'%&)%.4,%409()%*+(&)=%
b,+,*%b/+.,<=%GTTWoOWEOOIhGAG@C@O=%L50*%GTTWgTGgGS=%
H=% J,&)*,+6%$#8%J&77&(9'%bs8%$/',+%b=%?4,%'/3&(7%3/)'.&.0,).'%/2%
'(1/9('/34&'9=%#/3&(7%X+/*7,9'=%O`WVE@OIh@H`CW`=%
W=% #0..,+%s8%^&)',:%>b8%X/9,+/:%J!=%#,<0(7%*,4(-&/0+%&)%.4,%409()%2,9(7,=%
X/507(.&/)=%O`AVo`hHSA=%
`=% ",2+&)%a8%>+(1%$8%!,)C#(''/)%$X8%K&)Q*0+6%^=%>..&.01,'%()1%,9/.&/)'%
./;(+1'%5(&)%()1%',)'&.&-&.:%./%5(&)207%'.&907&%(9/)6%5,/57,%+/0.&),7:%,)6(6&)6%
&)%9('/34&'.&3%*,4(-&/0+=%L0+%s%X(&)=%GTOAoO`E`IhO@GOC@T=%L50*%GTOAgTGgO`=%
OT=% ^7,9,).%^a8%R,,%L$8%>9*7,+%s^8%M()'/)%#>8%b/9*,+%L8%J&,..&)6%"8%,.%(7=%
L<.+,9,%+&.0(7'%&)%(%!"#$%3/).,<.h%.4,%54:'&/7/6&3(7%()1%5':34/7/6&3(7%,22,3.'%/2%
.4,%l"()3,%/2%#/07'l=%b07.0+,8%4,(7.4%t%',<0(7&.:=%GTOHoO`EVIhVA@CS`=%L50*%
GTOSgOTgOS=%
OO=%#(6(+&)%!s8%b0.7,+%!8%b0.7,+%d8%R(;7,+C#(6(+&)%^>8%$(.0'Q,;&34%R=%
M/+9/)(7%34()6,'%()1%3/057,%*/)1&)6%&)%3/)',)'0(7%'(1/9('/34&'.&3%(3.&-&.:=%
>+34&-,'%/2%',<0(7%*,4(-&/+=%GTT`o@WEGIhOWSCGTT=%L50*%GTTWgTSgGT=%
OG=% s(90+.('%>f8%?/2('%?8%B(./0+/'%D8%d&N/7(&1&'%$K8%X('34(7&'%e8%u2().&%b8%,.%(7=%
?4,%,22,3.'%/2%7/;%()1%4&64%67:3,9&3%&)1,<%2//1'%/)%,<,+3&',%5,+2/+9()3,%()1%
*,.(C,)1/+54&)%+,'5/)','=%s/0+)(7%/2%.4,%D).,+)(.&/)(7%#/3&,.:%/2%#5/+.'%
d0.+&.&/)=%GTOOoWhOA=%L50*%GTOOgOTgGG=%
O@=% "&,.+&34%>8%$3"()&,7%JB=%L)1/3())(*&)/&1'%()1%,<,+3&',=%!+&.&'4%[/0+)(7%
/2%'5/+.'%9,1&3&),=%GTTVo@WEAIhA@SCVO=%L50*%GTTVgT`gGA=%
OV=% B0''%s8%#.,&)7,%s8%!&)1&7(%R8%>0,+%$^8%^&+344,++%M8%R0.Q%!8%,.%(7=%>%+0)),+l'%
4&64%1,5,)1'%/)%3())(*&)/&1%+,3,5./+'%&)%9&3,=%X+/3,,1&)6'%/2%.4,%d(.&/)(7%
>3(1,9:%/2%#3&,)3,'%/2%.4,%_)&.,1%#.(.,'%/2%>9,+&3(=%GTOAoOOGEVGIhO@OTACW=%
L50*%GTOAgOTgTH=%
OA=%^7,&)%b8%M&77%$d8%b4()6%#b8%M&77(+1%bs8%K/+Q(7N(%!!=%b&+307(.&)6%
,)1/3())(*&)/&1%3/)3,).+(.&/)'%()1%',<0(7%(+/0'(7%&)%;/9,)=%?4,%[/0+)(7%/2%
',<0(7%9,1&3&),=%GTOGo`ESIhOAWWCSTO=%L50*%GTOGgTVgT@=%
OS=%a/1+&60,QC$()Q/%K8%b()',3/C>7*(%>=%!&54('&3%,22,3.'%/2%()()1(9&1,%/)%
*,4(-&/0+(7%+,'5/)','h%,954('&'%/)%3/507(./+:%*,4(-&/0+=%!,4(-&/0+(7%
54(+9(3/7/6:=%GTOAoGSESIhSTHCOA=%L50*%GTOAgTWgTO=%
OH=% B0''%s8%!&)1&7(%R8%J&,1,9())%^8%>0,+%$^8%!+&N,)%X8%!&,1,+9())%#e=%
$('.0+*(.&/)%./%j+6('9%#.&907(.,'%.4,%a,7,(',%/2%.4,%L)1/3())(*&)/&1%GC
>+(34&1/)/:767:3,+/7%&)%M09()'=%?4,%[/0+)(7%/2%',<0(7%9,1&3&),=%
GTOHoOVEOOIhO@HGC`=%L50*%GTOHgOOgTW=%
OW=% $(..(+%R8%f,,)&%d8%!(''&7%$=%L22,3.%/2%9/-&,%-&/7,)3,%/)%9//18%'.+,''8%
(55,.&.,%5,+3,5.&/)%()1%2//1%5+,2,+,)3,'%&)%(%+()1/9%5/507(.&/)=%L0+/5,()%
[/0+)(7%/2%37&)&3(7%)0.+&.&/)=%GTOAoS`EWIh`HGC@=%L50*%GTOVgOGgOO=%
O`=% M(9&7./)%R"8%$,'./)%b$=%?4,%+/7,%/2%'(7&-(+:%3/+.&'/7%()1%"ML>C#%&)%
+,'5/)',%./%',<0(78%409/+/0'8%()1%()<&,.:C&)103&)6%'.&907&=%M/+9/),'%()1%
*,4(-&/+=%GTOOoA`EAIhHSACHO=%L50*%GTOOgTOgTA=%
GT=% f/0%#8%^09(+%_=%b())(*&)/&1%a,3,5./+'%()1%.4,%L)1/3())(*&)/&1%
#:'.,9h%#&6)(7&)6%()1%B0)3.&/)%&)%.4,%b,).+(7%d,+-/0'%#:'.,9=%D).,+)(.&/)(7%
[/0+)(7%/2%9/7,307(+%'3&,)3,'=%GTOWoO`E@I=%L50*%GTOWgT@gOV=%
GO=% b()',3/C>7*(%>8%a/1+&60,QC$()Q/%K=%#,<0(7%&).,+(3.&/)%&'%,'',).&(7%2/+%.4,%
.+()'2/+9(.&/)%/2%)/)C3/507(.&)6%+(.'%&)./%',<0(77:%(3.&-,%()&9(7'%*:%.4,%
,)1/3())(*&)/&1%()()1(9&1,=%!,4(-&/0+(7%*+(&)%+,',(+34=%GTO`o@A`hVOWCGH=%
L50*%GTOWgOOgOS=%
GG=% $,9/'%d^8%e,7(%a8%?(*/),%b8%K0(++(3&%B>=%L)1/3())(*&)/&1%&)270,)3,%/)%
5(+.),+%5+,2,+,)3,%&)%2,9(7,%+(.'=%X4(+9(3/7/6:8%*&/34,9&'.+:8%()1%*,4(-&/+=%
GTOVoOGVh@WTCW=%L50*%GTOVgTHgGG=%
G@=% #&907(%!R=%>%v"&22,+,).%L3/)/9:%/2%!/1&,'%()1%X7,('0+,'vih%
"&22,+,).&(.&)6%()1%L-(70(.&)6%#,<%()1%#,<0(7%!"#$%L<5,+&,)3,'=%s/0+)(7%/2%
4/9/',<0(7&.:=%GTOHhOCG`=%L50*%GTOHgOTgGH=%
GV=% ^0+.%M8%a/),7%d=%>11&3.,1%./%X(&)h%>%X+,7&9&)(+:%$/1,7%/2%#,<0(7%
$('/34&'9%('%>11&3.&/)=%D).,+)(.&/)(7%[/0+)(7%/2%/22,)1,+%.4,+(5:%()1%
3/95(+(.&-,%3+&9&)/7/6:=%GTOHoSOEOAIhOHSTCHV=%L50*%GTOSgTGgTS=%
GA=% b4:,%u8%b4+&'.,)',)%L8%#/7/;&[%d8%u03,7%$=%?4,%L)1/3())(*&)/&1%#:'.,9%
()1%b())(*&1&/7l'%X+/9&',%2/+%.4,%?+,(.9,).%/2%#0*'.()3,%_',%"&'/+1,+=%
B+/).&,+'%&)%5':34&(.+:=%GTO`oOThS@=%L50*%GTO`gT@gTH=%
GS=%^/.,N%!8%X(34/(7%M8%$(+.&)'%$8%X(''&6%$8%s()1,+%s8%R,&'&%d=%#$%
D).,+)(.&/)(7=%s/0+)(7%/2%4/9/',<0(7&.:=%GTTWoATEGC@IhGS@CWT=%
GH=% B0''%s8%K(''%X=%L)1/3())(*&)/&1'%()1%-/70).(+:%(3.&-&.:%&)%9&3,h%+0)),+l'%
4&64%()1%7/)6C.,+9%3/)',P0,)3,'%&)%,9/.&/)(7%*,4(-&/+'=%L<5,+&9,).(7%
),0+/7/6:=%GTOToGGVEOIhOT@CA=%L50*%GTOTgTVgTO=%
GW=%B+,01%#=%?4+,,%,''(:'%/)%.4,%.4,/+:%/2%',<0(7&.:=%R/)1/)h%M/6(+.4%X+,''o%
O`TA=%
%
%
% %
Table!1:!Demographic!and!clinical!variables!
%
%
"/9&)().'%
E)F@VI%
#0*9&''&-,'%
E)F@@I%
b/).+/7'%
E)FGVI%
?,'.%5%-(70,%
>6,%E:I%
VV=A%±%OO=@%
@W=G%±%OO=@%
@V=@%±%OT=GS%
=TTGSn%
K,)1,+%
$h%G@%ESWUI%
Bh%`%EGAUI%
/.4,+%G%ESUI%
$h%W%EGVUI%
B%GV%EH@UI%
j.4,+h%O%E@UI%
$%O@%EAVUI%
B%OO%EVSUI%
j.4,+h%g%
=TT@Ap%
L103(.&/)%7,-,7%
E)oUI%
O%
G%
@%
%
O%E@UI%
OA%EVVUI%
OW%EA@UI%
%
%O%E@UI%
OA%EVAUI%
OH%EAGUI%
%
T%ETUI%
A%EGOUI%
O`%EH`UI%
=G@Wn%
!"D%E$,()8%+()6,I%
@=O%ETCOOI%
@=`%ETCOGI%
A=G%ETCOGI%
=OTOn%
!$D%
GW=T%±%A=@%
GH=H%±%H=@%
GV=V%±%V=T%
=TVSHn%
%
L103(.&/)%7,-,7h%OF%4&64%'34//7%0)2&)&'4,1o%G%F%4&64%'34//7%2&)&'4,1o%@h%4&64,+%
,103(.&/)%E3/77,6,g0)&-,+'&.:I%
n%j),;(:%>)/-(%()(7:'&'%%
p%b/).&)6,)3:%()(7:','%EX,(+'/)I%
%
%
%
%
%
%
%
%
%
%
%
%
%
% %
Table!2:!Mean!Biomarker!concentrations!(reported!as!mean(SD))!of!the!
three!groups!at!the!three!assessment!times!
%
GC>KF%GC(+(34)&1/)/:767:3,+/7o%>L>F%>)()1(9&1,%
%
%
Table!3:!Delta!scores!(Mean,!SD)!between!measures!for!biomarkers!of!the!
three!groups!(Dominants,!Submissives,!Controls)!
%
%
"/9&)().'%
b/).+/7'%
?OC?G%
?GC?@%
?OC?G%
?GC?@%
?OC?G%
?GC?@%
b/+.&'/7%
1,7.(%'3/+,%
@=S%
EVG=VI%
H=@%
EOW=WI%
CH@=A%
EOTO=OI%
OS=O%
EHW=AI%
CV=@%
E@A=HI%
CS=H%
EGT=`I%
*,.(C
,)1/+54&)%
1,7.(%'3/+,%
CO=W%
EOO=WI%
CO=T%
EOG=WI%
CG=W%EH=`I%
T=G%
EOT=AI%
CT=W%ES=WI%
T=`%ES=AI%
GC>K%%
1,7.(%'3/+,%
A=O%
E@H=AI%
CA=H%
EVO=AI%
C@G=H%
EOWS=WI%
@W=O%
EOH`=GI%
AH=S%
EG`H=@I%
CG=H%
EGW=WI%
>L>%%
1,7.(%'3/+,%
OH=`%
EWO=TI%
C@=S%
EVG=OI%
C@`=`%
EOVO=HI%
@A=G%
EO@A=HI%
G@=A%
EAO=SI%
C@O=G%
EHS=SI%
%
%
%
%
%
%
"/9&)().'%%
#0*9&''&-,'%%
%
b/).+/7'%
%
%
?O%
?G%
?@%
?O%
?G%
?@%
?O%
?G%
?@%
b/+.&'/7%
E)6g97I%
OSA=V%%
EGAS=AI%
O@W=`%
EGVS=VI%
OO@=T%
EO@G=@I%
OHT=H%
EOVH=SI%
GGT=S%
EOHV=HI%
GOG=@%
EOWS=TI%
WT=O%
EVA=@I%
`S=V%
EHW=WI%
OT@=G%
EWG=WI%
*,.(C
,)1/+54&)%
E56g97I%
@@=A%
EOT=GI%
@V=O%%
EOO=SI%
@A=O%
E`=HI%
@G=S%
EW=@I%
@A=V%
EW=`I%
@A=T%
EW=WI%
@A=G%
EW=TI%
@S=T%
ES=AI%
@V=W%
EW=TI%
GC>K%%
E)6g97I%
GSS=H%
E@O@=HI%
GSO=S%
E@OO=WI%
GSO=H%
EG`T=`I%
@HH=O%
E@SG=@I%
V@O=V%
E@HO=WI%
@`W=@%
E@HT=AI%
@AS=S%
E@H@=OI%
G`O=S%
EGAH=@I%
@TG=`%
EGA`=HI%
>L>%%
E)6g97I%
GTV=G%
EGS@=TI%
OWS=@%
EGAS=`I%
OWW=H%
EGSG=VI%
G`A=T%
E@GG=@I%
@GW=O%
E@@A=OI%
G`W=`%
E@GA=VI%
GTA=V%
EGG@=SI%
OWG=T%
EO`G=@I%
GO@=O%
EGVO=VI%
Figure!1:!!
!&/9(+N,+%7,-,7'%/)%1/9&)().'%E)F@VI8%'0*9&''&-,'%E)F@@I%()1%3/).+/7'%E)FGVI%
/)%?O%E5+,%57(:%*(',7&),I8%?G%E5/'.%57(:I%()1%?@%E5/'.%(2.,+3(+,8%&=,=%OACGT%
9&)0.,'%(2.,+%?GI=%B&60+,%O(h%b/+.&'/7%7,-,7'%E)6g97Io%B&60+,%O*h%*,.(C,)1/+54&)'%
E56g97Io%2&60+,%Obh%>)()1(9&1,%E>L>o%)6g97Io%2&60+,%O1h%GC(+(34&1/)/:767:3,+/7%
EGC>Ko%)6g97I%
%
%
%
%
... Previous research by our group demonstrated an association between BDSM activities and reductions in plasma cortisol levels in dominant participants, which was suggested to potentially reflect stress-reducing effects in BDSM interactions (Wuyts et al., 2020). As such, it could be hypothesized that dominant BDSM practitioners engage in these activities as a coping style for every day stress. ...
Article
Full-text available
Despite the gaining popularity in mainstream media of the phenomenon that is BDSM, empirical research on the motives and underlying psychological mechanisms driving BDSM practitioners is scarce. The current study focused on the potential driving roles of sensation seeking and coping styles in BDSM-related interests and behavior. A cross-sectional survey questionnaire was completed by 256 Dutch-speaking BDSM practitioners (110 men, 135 women, 7 gender fluid, 2 genderless, 1 other not specified), 1 missing (this participant did not answer the question regarding gender, but did answer all other survey items) and a matched control group lacking any BDSM interest recruited from the general Belgian population (N = 300; 135 men, 158 women, 4 gender fluid, 3 genderless). The questionnaire consisted of several items surveying different BDSM identities and interest levels of BDSM-related activities, an adapted version of the Dutch Sensation Seeking Scale, and items querying seven coping styles. Compared to controls, BDSM practitioners reported significantly higher levels of sensation seeking for all dimensions (experience seeking, thrill seeking, and distraction seeking), as well as the use of more active coping skills such as problem solving and taking action. Gender differentiated which specific coping skills were being used with women seeking out more emotional support and comfort and reaching out more for help and advice in both the BDSM and control group, and men taking more action and seeking distraction in leisure. About 40% of the practitioners reported using BDSM itself as a coping strategy. Further research is needed to explore the link between coping and sexuality in general, and to other psychological processes that drive BDSM interests in order to destigmatize and normalize consensual BDSM-related activities within the general population.
Article
Full-text available
Background: BDSM (Bondage and discipline, Dominance and submission, and Sadism and Masochism) increasingly receives attention from the scientific community. Where earlier research efforts mainly focused on epidemiological characteristics, psychological and biological factors driving BDSM preferences have recently gained interest as well. Aim and Methods: The current systematic review brings together all the existing literature on BDSM from a biopsychosocial perspective. Results: Biological factors like gender identity, sex hormone levels and the neurological constitution of the brain’s pain and reward systems influence BDSM orientation. With regard to psychological factors, both personality traits (f.i. higher levels of openness or extraversion) and the presence of a personality disorder have been associated to a heightened BDSM interest, although only limited supporting evidence is available. Additionally, sensation seeking levels and impulsivity seem to contribute, as they presumably guide one’s drive to explore new and/or more intense kinks. As attachment styles impact couple dynamics they also influence willingness to explore limits in a BDSM context. Lastly, education levels impact relational and/or sexual dynamics. Strengths and Limitations: The limitations of the current review reflect those of the topical scientific literature. Although the number of studies focused on all aspects of BDSM is exponentially growing, most of these are only descriptive and very few focus on underlying driving processes. Conclusion: From this biopsychosocial perspective, we offer a dimensional approach while integrating the factors driving the onset and evolution of BDSM interests.
Article
Full-text available
Substance use disorder is characterized by repeated use of a substance, leading to clinically significant distress, making it a serious public health concern. The endocannabinoid system plays an important role in common neurobiological processes underlying substance use disorder, in particular by mediating the rewarding and motivational effects of substances and substance-related cues. In turn, a number of cannabinoid drugs (e.g., rimonabant, nabiximols) have been suggested for potential pharmacological treatment for substance dependence. Recently, cannabidiol (CBD), a non-psychoactive phytocannabinoid found in the cannabis plant, has also been proposed as a potentially effective treatment for the management of substance use disorder. Animal and human studies suggest that these cannabinoids have the potential to reduce craving and relapse in abstinent substance users, by impairing reconsolidation of drug-reward memory, salience of drug cues, and inhibiting the reward-facilitating effect of drugs. Such functions likely arise through the targeting of the endocannabinoid and serotonergic systems, although the exact mechanism is yet to be elucidated. This article seeks to review the role of the endocannabinoid system in substance use disorder and the proposed pharmacological action supporting cannabinoid drugs' therapeutic potential in addictions, with a focus on CBD. Subsequently, this article will evaluate the underlying evidence for CBD as a potential treatment for substance use disorder, across a range of substances including nicotine, alcohol, psychostimulants, opioids, and cannabis. While early research supports CBD's promise, further investigation and validation of CBD's efficacy, across preclinical and clinical trials will be necessary.
Article
Full-text available
BDSM is an omnibus term covering a spectrum of activities within bondage/discipline, dominance/submission, and sadism/masochism relationships. To date, BDSM practitioners experience stigma due to a general unfamiliarity with the practice and marginalization of this type of sexual behavior. Destigmatization occurs partly through knowledge expansion and identification with the stigmatized group. In this study within the Belgian population, we aimed to characterize certain aspects of socioeconomic status and specific BDSM preferences of individuals with differing BDSM experience levels. We show that individuals who perform BDSM in a community setting (BDSM clubs, events. BDSM-CP) are generally higher educated, are significantly younger when first becoming aware of their inclination toward kink-oriented sex, and have a more strict BDSM role identity (Dom vs. Sub) than individuals who engage in BDSM-related activities in a private setting (BDSM-PP). This latter group in turn display a more pronounced Dom/Sub identification than individuals who only fantasize about the practice (BDSM-F). Our data indicate BDSM interest is a sexual preference already manifesting at early age, with role identification profiles becoming gradually more pronounced based on the practitioner’s contextual experience.
Article
Full-text available
The biological effects of cannabinoids, the major constituents of the ancient medicinal plantCannabis sativa(marijuana) are mediated by two members of the G-protein coupled receptor family, cannabinoid receptors 1 (CB1R) and 2. The CB1R is the prominent subtype in the central nervous system (CNS) and has drawn great attention as a potential therapeutic avenue in several pathological conditions, including neuropsychological disorders and neurodegenerative diseases. Furthermore, cannabinoids also modulate signal transduction pathways and exert profound effects at peripheral sites. Although cannabinoids have therapeutic potential, their psychoactive effects have largely limited their use in clinical practice. In this review, we briefly summarized our knowledge of cannabinoids and the endocannabinoid system, focusing on the CB1R and the CNS, with emphasis on recent breakthroughs in the field. We aim to define several potential roles of cannabinoid receptors in the modulation of signaling pathways and in association with several pathophysiological conditions. We believe that the therapeutic significance of cannabinoids is masked by the adverse effects and here alternative strategies are discussed to take therapeutic advantage of cannabinoids.
Article
Full-text available
Background: Bondage and discipline, dominance and submission, and sadism and masochism (BDSM) is gaining popularity through the mainstream media. Nevertheless, very little is known about the prevalence of BDSM-related fantasies and activities in the general population. Aim: To determine the prevalence of BDSM fantasies and behavioral involvement in four different age groups of the general population in Belgium. Methods: By use of a cross-sectional survey questionnaire, the level of interest in several BDSM-related activities was investigated in a sample representative of the general Belgian population (N = 1,027). The questionnaire evaluated interest in 54 BDSM activities and 14 fetishes. Self-identification as BDSM practitioner, situational context of BDSM practice, age at awareness of these interests, and transparency to others were queried. Outcomes: Individual item scores and summary scores on four BDSM categories were included in the analyses. Results: A high interest in BDSM-related activities in the general population was found because 46.8% of the total sample had ever performed at least one BDSM-related activity and an additional 22% indicated having (had) fantasies about it. Interestingly, 12.5% of the total population indicated performing at least one BDSM-related activity on a regular basis. When asked whether they saw themselves as being interested in BDSM, 26% stated this to be the case and 7.6% self-identified as BDSM practitioners. Interests in dominant and submissive activities were comparable and, remarkably, were highly intercorrelated. BDSM and fetish interests were significantly higher in men than in women. The older group (48-65 years) had significantly lower BDSM scores compared with their younger peers. Of participants with a BDSM interest, 61.4% became aware of it before 25 years of age. Clinical implications: There is a high level of interest in BDSM in the general population, which strongly argues against stigmatization and pathologic characterization of these interests. Strengths and limitations: This is the first thorough study concerning prevalence of interest in and fantasies about a wide range of BDSM-related activities in the general population worldwide. Although our findings tend to argue against it, we cannot completely rule out participation bias introduced by non-interest in the non-completers. In addition, some topics might have been subject to interpretation by the respondents. Conclusion: Interest in BDSM is present in most of the general population. Further research is needed to destigmatize it by confirming BDSM as a leisurely preference rather than a psychiatric affliction. Holvoet L, Huys W, Coppens V, et al. Fifty Shades of Belgian Gray: The Prevalence of BDSM-Related Fantasies and Activities in the General Population. J Sex Med 2017;XX:XXX-XXX.
Article
Full-text available
Participation in extreme rituals (e.g., fire-walking, body-piercing) has been documented throughout history. Motivations for such physically intense activities include religious devotion, sensation-seeking and social bonding. The present study aims to explore an extreme ritual within the context of bondage/discipline, dominance/submission and sadism/masochism (BDSM): the ‘Dance of Souls’, a 160-person ritual involving temporary piercings with weights or hooks attached and dancing to music provided by drummers. Through hormonal assays, behavioural observations and questionnaires administered before, during and after the Dance, we examine the physiological and psychological effects of the Dance, and the themes of spirituality, connectedness, transformation, release and community reported by dancers. From before to during the Dance, participants showed increases in physiological stress (measured by the hormone cortisol), self-reported sexual arousal, self-other overlap and decreases in psychological stress and negative affect. Results suggest that this group of BDSM practitioners engage in the Dance for a variety of reasons, including experiencing spirituality, deepening interpersonal connections, reducing stress and achieving altered states of consciousness.
Article
The endocannabinoid anandamide (AEA) transforms half of the population of previously non-copulating (NC) rats into sexually active animals in a long-lasting manner. The aim of this work was to explore the nature of this transformation. We identified the dose range in which AEA induces mating behavior in previously NC rats, which evidenced a dose-based, biphasic profile for AEA to induce the transformation of NC rats. We demonstrate that the sexual interaction with a receptive female, involving at least an intromission, is essential for AEA to induce the transformation of NC rats. This AEA-induced conversion is centrally mediated and involves the activation of CB1 receptors. Results indicate that the sexual impairment of this population of NC rats relies on their incapacity to initiate sexual activity and that an unidentified brain inhibitory influence on sexual behavior expression is removed by AEA treatment, allowing previously NC rats to show copulatory behavior in a long-lasting manner. The inhibitory influence is not removed by AEA treatment when animals are not allowed to have sexual contact with the female immediately after AEA injection. The same result was found for the opioid receptor antagonist naloxone, the other treatment reported to induce copulation in rats classified as NC. These data suggest that sexual behavior expression could depend on two different neural mechanisms at two different moments: one involved in the display of the first copulatory response and another responsible for maintaining subsequent sexual behavior responding.
Article
Background: Endocannabinoids are critical for rewarding behaviors such as eating, physical exercise, and social interaction. The role of endocannabinoids in mammalian sexual behavior has been suggested because of the influence of cannabinoid receptor agonists and antagonists on rodent sexual activity. However, the involvement of endocannabinoids in human sexual behavior has not been studied. Aim: To investigate plasma endocannabinoid levels before and after masturbation in healthy male and female volunteers. Outcomes: Plasma levels of the endocannabinoids 2-arachidonoylglycerol (2-AG), anandamide, the endocannabinoid-like lipids oleoyl ethanolamide and palmitoyl ethanolamide, arachidonic acid, and cortisol before and after masturbation to orgasm. Methods: In study 1, endocannabinoid and cortisol levels were measured before and after masturbation to orgasm. In study 2, masturbation to orgasm was compared with a control condition using a single-blinded, randomized, 2-session crossover design. Results: In study 1, masturbation to orgasm significantly increased plasma levels of the endocannabinoid 2-AG, whereas anandamide, oleoyl ethanolamide, palmitoyl ethanolamide, arachidonic acid, and cortisol levels were not altered. In study 2, only masturbation to orgasm, not the control condition, led to a significant increase in 2-AG levels. Interestingly, we also found a significant increase of oleoyl ethanolamide after masturbation to orgasm in study 2. Clinical Translation: Endocannabinoids might play an important role in the sexual response cycle, leading to possible implications for the understanding and treatment of sexual dysfunctions. Strengths and Limitations: We found an increase of 2-AG through masturbation to orgasm in 2 studies including a single-blinded randomized design. The exact role of endocannabinoid release as part of the sexual response cycle and the biological significance of the finding should be studied further. Cannabis and other drug use and the attainment of orgasm were self-reported in the present study. Conclusion: Our data indicate that the endocannabinoid 2-AG is involved in the human sexual response cycle and we hypothesize that 2-AG release plays a role in the rewarding consequences of sexual arousal and orgasm.
Article
This study examines how BDSM participants understand sexual experiences. Data are drawn from 32 in-depth, semi-structured interviews and discussion board threads from a large BDSM community website. The analysis suggests that many BDSM participants perceive sexual BDSM experiences as not only significantly different from but also better than mainstream or “vanilla” sex. Three primary differentiation mechanisms are identified. First, BDSM participants construct sex as requiring genital contact while framing sexual BDSM as creating sexual fulfillment not requiring normative indicators of sexual experiences (e.g. orgasm). Second, participants construct sexual BDSM as centered around emotional and mental experiences, while perceiving sex as being centered around physical experiences. Third, participants perceive sexual BDSM experiences as facilitating deeper interpersonal connections than those available in sex. Importantly, these mechanisms serve not only a differentiating but also an evaluative function. Most participants in this study report a strong preference for sexual BDSM over sex.
Article
An exploratory, qualitative, phenomenological study focused on the experience of pain while participating in sexual masochistic acts. Semi-structured interviews were conducted with nine individuals (four female, five male) who regularly participate in sexually masochistic acts and point to pain as central to their experience. Qualitative analysis of the data revealed several key characteristics of the participant's experience: the first time, intoxication, craving and withdrawal, tolerance, pain as control, and the pain inducing partner. The findings indicate that the way pain is experienced while mitigated through masochistic behavior creates an addictive process that coincides with a chronic behavioral spin contextualization. This article presents a preliminary model of addiction to physical pain in light of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) definition of substance-related and addictive disorders and the behavioral spin theory.